Written by a Medical Acupuncture for Veterinarians course graduate. Author’s name available upon request. Signed release obtained from client/author/4396.
Primary front foot pain in a show horse can cause compensatory full body pathology, which leads to loss of training time and forced modifications in conditioning. This case report examines the diagnosis and treatment of primary deep digital flexor calcification, pedal bone lysis, multi-joint arthritis, and hoof abnormalities which led to overall muscle and joint pain. This horse was treated with adjunctive regular acupunture which alleviated associated muscle tightness and pain, as well as improved comfort of the front feet in order to temporarily return to show form. Pre-existing conditions and poor shoeing however prevented optimal results.
In November, 2015 “Ralph,” an 11-year-old American Saddlebred gelding, presented for pre-purchase exam for use as a gaited pleasure show horse and long-term ownership. During this exam he exhibited superficial heel sensitivity, hind fetlock effusion, 2/5 left front lameness and 1/5 right hind lameness. He was purchased despite warnings of long-term soundness problems. For the following several months he presented for increasingly significant front end lameness during work. During the time period of December 2015 to April 2016 through local nerve diagnostic anesthesia, ultrasound, and radiographs, he was diagnosed with bilateral deep digital flexor calcification and tendonitis, navicular syndrome, multi-joint degenerative joint disease, and white line disease of the front feet. He also had perpetually long toes and asymmetrical heel hight despite regular trimming and shoeing in a stacked heel. The navicular bursas, front coffin joints, stifles, and hocks were all injected during this time period with hyaluronic acid and corticosteroids. He was also intermittently administered non-steroidal anti-inflammatories, methocarbamol, and isoxuprine. By March he began exhibiting a severe rocked back painful gait coming out of the stall and subsequently became severely painful in his caudal gluteal and hamstring muscles. His temperament became very sour and he would kick out when touched on his caudal back and rump area. In March, 2016 mesotherapy of the hind end was performed, and in April shockwave of the palmar aspects of the front feet.
It became apparent that acupuncture would be a very useful adjunctive treatment for Ralph to treat local muscle and nerve pain, as well as soft tissue and muscle tightness that was occurring from compensatory gait changes (rocking weight to hind end, higher head carriage to take stress of front feet). Later developments would also precipitate a need for increased blood flow to the front feet and breakdown of scar tissue associated with laminitis and inflammation of the flexor tendons. An attached video, labeled “PRE”, exhibits his painful gait prior to treatment.
April 29, 2016 a preliminary diagnostic myofacial palpation exam was performed. The gelding came out of the stall with a stiff gait. He was being treated with Methocarbamol and Previcox daily. He had a very poor temperament and was quick to strike, kick, and bite. This influenced treatment on that day as well as subsequent acupuncture treatments. On April 29th he exhibited severe reactivity at the poll, pain at cervical vertebrae 6-7, gluteal pain, poor neck bend to the left, and no upward movement of the withers. As it was his first acupuncture treatment and he had a very sour disposition, the location and number of acupuncture points were limited. TH-16, ST-10 and LI 16-18 were performed to treat associated neck pain and anxiety (LI-16). LI-11 was placed for front end inflammation and pain. BaiHui and BL-54 were used to treat gluteal and hind end pain. Dry needling was performed in all cases with majority of points being 30g X 30 Seirin needles. Vast improvement was seen after the first treatment but it was unknown if the shockwave or acupuncture, or both, had the greatest influence.
May 9th another acupuncture treatment was performed without any other changes in treatment. On this day Ralph was extremely wound up. He had more pronounced pain at the poll and cranial cervical regions, but much improved in reactivity to caudal cervical palpation and left gluteal pain. However, his right sacroiliac and gluteal regions were extremely painful, and he eventually needed to be sedated for treatment to be performed. 30g Seirins were placed at BL-10, TH-16, SI-16, and LI16-17 for poll and neck pain. LI-11 and Qian ti men were placed bilaterally for front end lameness and navicular disease. His lumbosacral, sacroiliac, and hind end tightness was addressed by placing needles at BaiHui, BL-54, BL-26, as well as three 25g right sided lumbosacral huatuojiaji. The attached “POST” video was taken two days after this treatment, where he shows no signs of lameness at the walk. This was the most significant response that he exhibited. He was again shockwaved on May 11, the day of the video, before leaving for a show.
May 16th, post-showing, an abreviated acupuncture treatment was performed. Pain was found again at the right poll and right gluteals most signficantly. He was treated at BL-10, TH-16, SI-16, LI 16-17 for neck/poll pain and SI-9 for generalized thoracic limb pain. Bai hui and BL-26 were also placed to address back and pelvic limb soreness.
From the end of May, 2016 to September, 2016 acupuncture was performed by another veterinary practice and it is unknown what treatments were performed. During this time however, Ralph sustained a quarter crack to the right front foot, suffered trauma to the left front foot wall while traumatically tearing off his shoe, and began to have rotation of the right front coffin bone. Lysis of the left front pedal bone was also found in August of 2016. September 13, 2016 IRAP was performed in all four fetlocks, upper and lower hock joints, front coffin joints and navicular bursas.
September 17, 2016 another myofascial palpation exam was performed. There was great improvement in reactivity of the caudal cervical region and gluteals. Bilaterally the poll and withers were painful, as well as bilateral triceps trigger points. His front end was severely painful and again exhibited a rocked-back very slow gait in front. At this time with the help of blinkers, all six ting points of the front feet were performed (TH-1, SI-1, HT-9, LI-1, LU-11, PC-9), as well as BL-10, TH-16, LI-16, LI-17, SI-10, and SI-9. Due to temperament, only TH-15 and BL-12 were placed to treat withers pain, as well as BaiHui for the hind end.
Subsequent treatments were performed 9/22 and 10/6. He again was treated at all six front ting points, and previous corresponding poll and caudal cervical points. LU-1, LI-6, LI-7, LI-11, and GB-21 were also added in for thoracic limb pain. During these months Ralph was no longer in work, and had been taken out of stacked shoes. His shoe angles were dropped to zero in his front feet and he was barely able to walk out of the stall.
While the overall condition of Ralph’s front feet deteriorated, I believe acupuncture was valuable in relieving compensatory muscle pain and myofascial restrictions, as well as cervical nerve and muscle pain. His overall coat and body condition, as well as his stall temperament improved while he was receiving treatments. Early on in treatment there were obvious improvements in his gait, and overall improvement in performance. After the first two acupuncture treatments, along with two treatments of shockwave, Ralph received the highest score in a show class that he had earned since being purchased. Because of these positive results, acupuncture treatment was encourgaged and accepted, however due to the horse’s temperament, a satisfactory regimen was never performed. Pre-existing pathology and problems with compliance with shoeing recommendations caused his front feet lameness to worsen. He is currently being treated by a veterinary podiatry referral specialist with hopes of pasture soundness, if not return to show performance. I would encourage future acupuncture treatment for him to alleviate overall muscle soreness and promote anti-inflammatory effects.